Individual
ANDRE D GRISHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9250 SW HALL BLVD, TIGARD, OR 97223-6721
(503) 221-0161
Mailing address
800 SW 13TH AVE, PORTLAND, OR 97205-1902
(503) 221-0161
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
29462
SC
208600000X
Surgery Physician
38146
TN
208600000X
Surgery Physician
Primary
MD151172
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04951725
—
MS
05
—
3895467
—
TN
01
—
4214668
BCBS TN
TN
Enumeration date
02/14/2006
Last updated
07/21/2022
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